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Deterministic method is a numerical calculation method based on photon-electron coupled transport with high computational accuracy and speed, which has been widely applied in photon radiotherapy dose calculation in recent years. However, this method has been introduced into radiotherapy for only a short period of time, which has been rarely studied in China, and systematic understanding of its characteristics is still lacking. In this article, the principles of deterministic method, current development state and clinical application were reviewed, aiming to provide reference for carrying out relevant research.
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Objective To analyze survival benefits of radiotherapy in patients with nasopharyngeal carcinoma (NPC) with distant metastases and analyze relevant prognostic factors.Methods Medical records of 329 patients newly diagnosed with metastatic NPC screened from the Surveillance,Epidemiology and End Results (SEER) database (199 of 329 patients received radiotherapy) between 2010 and 2015 were retrospectively analyzed.Overall survival (OS) and disease-specific survival (DSS) were calculated by Kaplan-Meier curve.The effect of different clinicopathological factors on the clinical prognosis of metastatic NPC patients was evaluated by logrank test and Cox regression analysis.Results The median follow-up time was 12 months.The 3-and 5-year OS rates were 27.4％ and 19.7％.The median OS was 17.9 months.Univariate analysis demonstrated that patients aged＜ 50 years,male,undifferentiated type,stage T3 or T4,positive regional lymph node,brain and liver metastases and 1-2 metastatic sites obtained OS and DSS benefits at 3 years after radiotherapy.Univariate and multivariate Cox analyses after propensity score matching showed that radiotherapy was an independent prognostic factor for metastatic NPC (OS,P=0.004;DSS,P=0.014).Besides,patients aged 60-69 years (OS,P=0.033;DSS,P=0.045),keratinizing squamous cell carcinoma (OS,P＜ 0.05;DSS,P＜ 0.05),stage T4 (OS,P =0.002;DSS,P =0.024),1-2 metastatic sites (OS,P =0.039;DSS,P =0.058),3-4 metastatic sites (OS,P =0.003;DSS,P =0.005) and no chemotherapy (OS,P=0.000;DSS,P=0.000) had poor OS and DSS,whereas sex,race and degree of differentiation exerted no effect on OS and DSS.Conclusions Radiotherapy can significantly improve the OS and DSS of patients with metastatic NPC.Prospective and randomized controlled studies are required to further explore the role of radiotherapy in the management of metastatic NPC.
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Objective To study the effect of remifentanil combined with propofol target-controlled infusion on anesthesia of gynecological laparoscopic surgery.Methods From August 2016 to August 2018,132 patients who needed to undergo gynecological laparoscopy in the Maternal and Child Health Care Hospital of Qujing were selected.The patients were randomly divided into two groups according to the principle of simple randomization,with 66 cases in each group.The observation group was given.remifentanil combined with propofol administered by target-controlled infusion for anesthesia.The control group were given fentanyl intravenous anesthesia.The clinical efficacy of the two groups was observed.Results The onset time of anesthesia [(1.3 ± 0.3) min],awake time [(5.2 ±1.5) min],anesthesia recovery time [(19.6 ± 5.3) min] and analgesic time [(23.6 ± 3.5) min] in the observation group were all shorter than those in the control group[(3.1 ± 0.6) min,(5.0 ± 3.5) min,(4.06 ± 4.8) min,(48.3 ±4.4) min] (t =12.742,15.102,11.265,12.354,all P ＜ 0.0).At 1 min after hemodynamic intubation,10 min after pneumoperitoneum,30 min after operation and 30min after operation,the heart rate,systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the observation group were (82.38 ± 7.45) times/min,(85.65 ± 8.54) times/min,(77.58 ± 8.65) times/min,(80.12 ± 7.77) times/min,SBP:(136.25 ± 20.14) mmHg,(140.36 ± 18.02) mmHg,(129.14 ± 15.24) mmHg,(131.25 ± 16.19) mmHg,DBP:(986.45 ± 11.02) mmHg,(86.59 ± 10.11) mmHg,(80.17 ± 8.29)mmHg,(82.52 ± 8.17)mmHg,which were better than those in the control group[herat rate:(88.14 ± 10.01) times/min,(95.36 ± 8.48) times/min,(86.58 ± 7.33) times/min,(87.48 ± 8.47) times/min;SBP:(140.28 ±21.57) mmHg,(144.59 ± 21.35) mmHg,(137.33 ± 18.47) mmHg,(136.25 ± 18.47) mmHg;DBP:(90.0 ± 10.14) mmHg,(90.25 ± 11.24) mmHg,(84.25 ± 10.14) mmHg,(82.55 ± 8.84) mmHg] (F =1.320,1.245,1.365,all P ＜ 0.05).Conclusion Remifentanil combined with propofol target controlled infusion for patients undergoing gynecological laparoscopic surgery is helpful to enhance the anesthetic effect,and has a short pharmacodynamic effect,which is conducive to ensuring the quality of surgery.Therefore,it is worthy of popularizing in clinical practice.
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Objective@#To study the effect of remifentanil combined with propofol target-controlled infusion on anesthesia of gynecological laparoscopic surgery.@*Methods@#From August 2016 to August 2018, 132 patients who needed to undergo gynecological laparoscopy in the Maternal and Child Health Care Hospital of Qujing were selected.The patients were randomly divided into two groups according to the principle of simple randomization, with 66 cases in each group.The observation group was given.remifentanil combined with propofol administered by target-controlled infusion for anesthesia.The control group were given fentanyl intravenous anesthesia.The clinical efficacy of the two groups was observed.@*Results@#The onset time of anesthesia[(1.3±0.3)min], awake time[(5.2±1.5)min], anesthesia recovery time[(19.6±5.3)min]and analgesic time[(23.6±3.5)min]in the observation group were all shorter than those in the control group[(3.1±0.6)min, (5.0±3.5)min, (4.06±4.8)min, (48.3±4.4)min](t=12.742, 15.102, 11.265, 12.354, all P<0.0). At 1 min after hemodynamic intubation, 10 min after pneumoperitoneum, 30 min after operation and 30min after operation, the heart rate, systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the observation group were (82.38±7.45)times/min, (85.65±8.54)times/min, (77.58±8.65)times/min, (80.12±7.77)times/min, SBP: (136.25±20.14)mmHg, (140.36±18.02)mmHg, (129.14±15.24)mmHg, (131.25±16.19)mmHg, DBP: (986.45±11.02)mmHg, (86.59±10.11)mmHg, (80.17±8.29)mmHg, (82.52±8.17)mmHg, which were better than those in the control group[herat rate: (88.14±10.01)times/min, (95.36±8.48)times/min, (86.58±7.33)times/min, (87.48±8.47)times/min; SBP: (140.28±21.57)mmHg, (144.59±21.35)mmHg, (137.33±18.47)mmHg, (136.25±18.47)mmHg; DBP: (90.0±10.14)mmHg, (90.25±11.24)mmHg, (84.25±10.14)mmHg, (82.55±8.84)mmHg](F=1.320, 1.245, 1.365, all P<0.05).@*Conclusion@#Remifentanil combined with propofol target controlled infusion for patients undergoing gynecological laparoscopic surgery is helpful to enhance the anesthetic effect, and has a short pharmacodynamic effect, which is conducive to ensuring the quality of surgery.Therefore, it is worthy of popularizing in clinical practice.
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Objective@#To compare the dosimetric differences among Target-Segmented Plan (TSP), Non-TSP, and conventional static 8-field intensity modulated radiation therapy (8F-IMRT) plan for post-mastectomy irradiation of left-sided breast cancer patients.@*Methods@#This study enrolled thirty consecutive breast cancer patients who underwent radical mastectomy and treated with post-op radiation in Department of Radiation Oncology, Renmin Hospital of Wuhan University from June 2017 to November 2018.The clinical target volume (CTV) included the ipsilateral chest wall, supra/infra-clavicular, high-risk partial axillary in high risk, and internal mammary nodes (IMN). The organs at risk (OARs) near the targets, including ipsilateral lung, heart, contralateral breast, ipsilateral humeral head and spinal cord, were contoured as well. The maximum distance of PTV′s tangent to the outermost side of the affected lung was more than 2 cm. Depending on the maximum distance, the patients were classified into three groups: A(<3 cm), B(3~4 cm) and C(>4 cm), respectively. Three types of treatment plans (TSP, Non-TSP and 8F-IMRT) were created for each patient using the Eclipse treatment planning system with the same dose optimization objective . The dose-volume histograms were compared for the PTVs and OARs.@*Results@#All plans achieved the intended dose criteria.The D98% of TSP was lower than that of Non-TSP and 8F-IMRT (Z=-3.294, -3.266, P<0.05). However, the homogeneity index (HI) and conformal index (CI) of the three plans had no statistically significant difference among the three plans (P>0.05). Non-TSP required more Monitor Units (MUs)than the other two plans (Z=-3.04, -2.669, P<0.05). The Dmean of TSP was higher than that of 8F-IMRT (Z=-3.181, P<0.05). Compared with Non-TSP and 8F-IMRT plans, TSP significantly reduced V5 Gy, V10 Gy, V20 Gy and Dmeanof ipsilateral lung and heart in all patients (lung: V5 Gy: Z=-3.408, -3.408; V10 Gy: Z=-3.408, -3.408; V20 Gy: Z=-3.408, -3.124; Dmean: Z=-3.408, -3.408, P<0.05; heart: V5 Gy: Z=-3.408, -3.408; V10 Gy: Z=-3.408, -3.408; V20 Gy: Z=-2.499, -3.067; Dmean: Z=-3.408, -3.408, P<0.05). The Dmean of contralateral breast in Non-TSP was higher than that in TSP and 8F-IMRT (Z=-2.954, -2.215, P<0.05), and the Dmaxhas no significant difference in (P>0.05). There was no significant difference in spinal cord Dmax among the three plans, but the Dmean of humeral head in 8F-IMRT was higher than that in TSP and Non-TSP (Z=-3.01, -2.442, P<0.05). In the three groups, the mean amplitude of difference comparing Non-TSP and 8F-IMRT with TSP in ipsilateral lung(V5 Gy, V10 Gy, V20 Gy) and heart(V5 Gy, V10 Gy, Dmean) satisfied the relation: D(N-T, A)<D(N-T, B) <D(N-T, C)和D(8F-T, A)<D(8F-T, B) <D(8F-T, C).@*Conclusions@#For post-mastectomy left-sided breast cancer patients, TSP is not only dosimetrically feasible as Non-TSP and 8F-IMRT treatment techniques, but also could effectively reduce the irradiation volume of the ipsilateral lung and heart in the low dose area with minimum adverse dosimetric impact on the treatment targets and other OARs.The advantage of TSP is more prominent with increasing curvature of the clinic target volume.
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As the leading cause of death among lung cancer patients, brain metastasis occurs in approximately 10 percent of non-small cell lung cancer (NSCLC) patients at first diagnosis.Whole-brain radiation therapy (WBRT) is still the standard treatment for patients with brain metastasis, however, the efficacy of WBRT reaches a plateau.It has been proved that tyrosine kinase inhibitors (TKIs) make considerable therapeutic effect for NSCLC patients with brain metastasis.The combination therapy of TKIs with WBRT may provide new major treatment for epidermal growth factor receptor (EGFR) mutant NSCLC with brain metastasis.
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Objective To explore the prognostic factors of brain metastases from primary breast cancer treated with stereotactic radiotherapy (SRT).Methods Retrospectively analyze 37 brain metastatic patients from primary breast cancer.Among these patients nineteen were treated with stereotactic radiotherapy alone,eight patients were treated with whole brain radiotherapy (WBRT) plus SRT,the other ten patients were intracranial recurrence after WBRT and treated with SRT for salvage.Kaplan-Meier analyses were used to calculate survival time.Logrank and Cox proportional hazards regression analyses were performed for univariate and multivariate analyses.Results The median follow-up time were 11 months and 15 months for the whole group and the alive.The median overall survival time was 11 months (95％ CI =6-16.month) for the whole group.The median overall survival time was 13.5 months for the whole group.In univariate analysis,the triple negative breast cancer (x2 =5.95,P =0.004),lower Karnofsky performance score (KPS,x2 =13.85,P =0.000),the interval between the diagnosis of the primary tumor and brain metastases ≤ 30 months (x2 =6.62,P =0.010),high RPA grade (x2 =15.35,P =0.000) and intracranial recurrence after whole brain radiotherapy (x2 =4.43,P =0.035) were negative prognostic factors for brain metastasis of breast cancer treated with stereotactic radiotherapy.In multivariate analyses,the triple negative breast cancer (x2 =9.58,P =0.008),lower KPS (x2 =6.65,P =0.010),and intracranial recurrence after whole brain radiotherapy (x2 =3.95,P =0.047) were negative prognostic factor.Conclusion The triple negative breast cancer,lower KPS,and intracranial recurrence after WBRT were negative prognostic factor for brain metastasis from primary breast cancer treated with SRT.
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ObjectiveTo summarize the results of stereotactic radiation therapy (SRT) with or without whole-brain radiotherapy (WBRT) in the treatment of multiple brain metastasis.MethodsFrom May 1995 to April 2010,totally 98 newly diagnosed multiple (2 - 13 lesions) brain metastases patients were treated in our centre.Forty-four patients were treated with SRT alone and 54 with SRT + WBRT.Dose fractionation schemes were 15 -26 Gy in 1 fraction or 24.0 -52.5 Gy in 2 - 15 fractions with 3.5 - 12.0 Gy per fraction,depending on the tumor volume,location,and history of prior irradiation.Kaplan-Meier and Cox proportional hazards regression analyses were used for survival analysis.The median age of the whole group was 55 years.The survival time was calculated from the date of radiation treatment to the day of death by any cause.ResultsThe median follow-up time for the whole group was 12 months,and the follow-up rate was 100％.The median overall survival time was 13.5 months for the whole group,there was no difference between SRT alone group and SRT + WBRT group ( 13.0 months vs.13.5 months,χ2 =0.31,P =0.578 ).The Karnofsky Performance Score ( KPS) at the time of treatment ( χ2 =6.25,P =0.012 ),the interval between the diagnosis of the primary tumor and brain metastases ( χ2 =7.34,P =0.025 ) and the status of extracranial metastases ( χ2 =4.20,P =0.040) were independent prognosis factors for survival in multivariate analyses.ConclusionsStereotactic radiation therapy is an effective and alternative treatment choice for multiple brain metastases.
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Objective Evaluation the Fractionated Stereotactic Radiotherapy (FSRT) for the patients with small-cell lung cancer (SCLC) after the whole brain radiotherapy (WBRT) failure.Methods We retrospectively analyzed 35 patients with brain metastases from small-cell lung cancer treated with linear accelerator FSRT after the WBRT failure. Multivariate analysis was used to determine significant prognostic factor related to survival.ResultsThe following-up rate was 100％.The median following-up time was 11 months.The median over-all survival (OS) time was 10.3( 1 -30) months after FSRT.Controlled extra cranial disease was the only identified significant predictor of increased median OS time (χ2 =4.02,P =0.045 ).The median OS time from the diagnosis of brain metastasis was 22 (6 - 134 )months.14 patients died from brain metastasis,14 from extra-cranial progression,1 from leptomeningeal metastases,and 3 from other causes. Local control at 6 months and 12 months was 91％ and 76％,respectively.No significant late complications.New brain metastases outside of the treated area developed in 17％ of patients at a median time of 4(2 -20) months; all patients had received previous WBRT.ConclusionsFractionated stereotactic radiotherapy was safe and effective treatment for recurrent small-cell lung carcinoma brain metastases.
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Objective To investigate the clinical effects, the therapy reactions,the living qualities of three treatments in advanced nasopharyngeal carcinoma. Methods From Jan 2001 to Jun 2002, 120 patients pathologically confirmed NPC who firstly underwent radiotherapy were divided into two groups: radiotherapy with concurrent chemotherapy group(RC, n = 60, 5 fractions per week, one time per day, 200 cGy per day to a total dose of 7 000 ～ 8 000 cGy. cisplatin and 5-Fu two cycles in the first and fourth week during radioation); radiotherapy with AiDi injection group(RAD, n = 60, radiotherapy was the same as that of RC. Continuously injecting AiDi for 10 days 50 ml per day was one cycle which was repeated 3 cycles every alternation of 7 days); another 60 patients who contemporaneity reciceved radiotherapy alone (radiotherapy was the same as that of RC) because of some reasons and were comparable in clilical materials were regarded as the third group (R) to compare with the above two groups. The life quality, 3-year survival rate, and acute or chronic radiation reactions in the three groups were observed. Results All patients were followed up for more than 3 years: the 3-year survival rate in RC (73.3%),which was homologous as that in RAD(65.0 %, P =0.347), was higher than that in R group(53.3%,P = 0.028), and the local recurrent was inverse(10.0%,26.7%,P = 0.033 6). The acute and chronic radiation reactions in RC was highest whereas that in RAD group is lowest(P